Bayo Babatunde Agbolade, PMHNP-BC

Key facts

NPI: 1780198192
Entity type: Individual (NPI type 1)
Primary specialty: Psychiatric/Mental Health Nurse Practitioner 363LP0808X
License: 277004414 (IL)
Practice address: 4711 Midlothian Tpke Ste 14
Crestwood, IL 60418-4903
Phone: (779) 910-8196
Fax: (708) 963-0105
NPI assigned: Nov 21, 2017
Sex: Male
Sole proprietor: Yes

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Edgewood Clinical Services, P.C. Psychologist · Naperville, IL · NPI 1295914646

Medicare reassignment Care Compare group NPD IL · SINGLE SPECIALTY
JBMV Health Associates, LLC Homemaker · Crestwood, IL · NPI 1508598335

Medicare reassignment IL
Psychology Specialists LTD Clinical Psychologist · Bloomington, IL · NPI 1053368605

NPD (past) SINGLE SPECIALTY

Medicare Care Compare profile

Specialty: Nurse Practitioner
Education: Other, 2021
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Telehealth: Offers telehealth services
Group practices: Edgewood Clinical Services P.C. (304 clinicians)

Practice addresses (Care Compare)

15303 S 94TH Ave
Suite 250
Orland Park, IL 60462-3825
Phone (888) 428-7890

4711 Midlothian Tpke
Suite 14
Crestwood, IL 60418-4903
Phone (779) 910-8196

Medicare participation

Medicare fee-for-service enrollment: Enrolled in IL
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20230802003697	IL	Practitioner - Nurse Practitioner	4688035959	Reassigns benefits to 2 organizations

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
277004414	IL	MD	Psychiatric/Mental Health Nurse Practitioner

Practice roles

Organization	Specialty	Status	New patients
Edgewood Clinical Services, P.C.	Single Specialty	Current since Mar 10, 2024	Accepting new patients
Psychology Specialists LTD	Single Specialty	Past	Accepting new patients

Locations

1616 N Damen Ave
Ste 301
Chicago, IL 60647
Phone (312) 761-4720

2948 Artesian Rd
Ste 112
Naperville, IL 60564
Phone (630) 328-0165

15303 S 94th Ave
Ste 250
Orland Park, IL 60462
Phone (708) 505-5205

Interoperability endpoints

Direct secure messaging: lifestancehealth.bayoagbolade@146897.advancedmd-direct.com

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Psychiatric/Mental Health Nurse Practitioner Group: 193400000X SINGLE SPECIALTY GROUP	363LP0808X	277004414	IL	Yes

Addresses

Primary practice location

4711 Midlothian Tpke Ste 14
Crestwood, IL 60418-4903

Mailing address

4711 Midlothian Tpke Ste 14
Crestwood, IL 60418-4903
Phone (708) 743-2714

Other providers in Crestwood, IL

All providers in Crestwood, IL · Psychiatric/Mental Health Nurse Practitioner in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2026. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.